UNAIDS calls for bold leadership to tackle prevention crisis

Around 1.8 million people became newly infected with HIV in 2017 and around 50 countries experienced a rise in new HIV infections as HIV prevention services are not being provided on an adequate scale or with sufficient intensity.

UNAIDS is urging countries to take bold action to address the HIV prevention crisis. Around 1.8 million people became newly infected with HIV in 2017 and around 50 countries experienced a rise in new HIV infections as HIV prevention services are not being provided on an adequate scale or with sufficient intensity.

“Health is a human rights imperative and we are deeply concerned about the lack of political commitment and the failure to invest in proven HIV programmes, particularly for young people and key populations,” said Michel Sidibé, executive director of UNAIDS. “If countries think they can treat their way out of their epidemics, they are dangerously mistaken.”

UNAIDS’ report, Miles to go: closing gaps, breaking barriers, righting injustices, shows that 47% of new HIV infections globally are among key populations. Although combination HIV prevention approaches work for key populations, including harm reduction, pre-exposure prophylaxis (PrEP), social care and condoms, many countries are unwilling to invest in approaches viewed as culturally or religiously inappropriate, unpopular or counter to the bad laws that may exist in a particular country.

HIV prevalence can be high as up to 70% among sex workers in some southern African countries; however, about three quarters of countries reporting to UNAIDS criminalize some aspect of sex work and sex workers report that condoms are often confiscated by the police.

In eastern Europe and central Asia, one third of all new HIV infections are among people who inject drugs; however, 87% of countries reporting to UNAIDS criminalize drug use or possession of drugs, driving people underground and out of reach of HIV services. Many countries do not make sterile injecting equipment and opioid substitution therapy widely available, which is a huge barrier to efforts to bring down new HIV infections among this population and their partners.

Gay men and other men who have sex with men accounted for around 57% of new HIV infections in western and central Europe and North America in 2017 and an estimated 41% of new infections in Latin America. However, globally, access to HIV services for men who have sex with men is still being blocked by bad laws. Of 100 countries reporting to UNAIDS, at least 44 had laws specifically criminalizing same-sex sexual intercourse. The death penalty applied in two countries.

“If countries don’t provide comprehensive sexuality education, condoms, harm reduction or pre-exposure prophylaxis for key populations, this will ultimately translate into more new HIV infections, higher future treatment costs and a higher burden for health-care budgets and systems,” said Sidibé.

Countries that have invested are seeing results. In Finland’s capital, Helsinki, for example, scale-up of harm reduction and HIV testing and treatment services led to a steep drop in new HIV infections and high rates of viral suppression among people who inject drugs. The number new HIV diagnoses in this key population decreased from more than 60 in 1999 to almost zero in 2014.

In San Francisco in the US, PrEP was added to programs that include HIV testing, rapid linkages to antiretroviral therapy and boosting support for retention in care. Between 2013 and the end of 2016, there was a 43% decrease in new HIV diagnoses in the city, a decline that is being attributed to both quicker achievement of viral suppression among people who test HIV-positive and to increased uptake of PrEP.

Women and girls also need access to HIV prevention. In 2017, around 6500 women and girls were infected with HIV every week. Limited access to education, a lack of economic autonomy and a lack of decision-making power, including over their own health, expose them to intimate partner violence, limit their ability to practice safer sex and limit their ability to benefit from HIV and sexual and reproductive health services, making them more vulnerable to HIV infection.

Women and girls must have the knowledge and power to protect themselves against HIV in safe and enabling environments and must be able to access services that meet their needs. This requires countries to reform discriminatory laws that perpetuate inequality and develop and enforce laws that promote gender equality.

Young people also need age-appropriate youth-friendly health services. More than two thirds of countries reporting to UNAIDS require parental consent for a child under 18 years to access HIV testing, and more than half require consent for HIV treatment.

While most countries have significantly scaled up their HIV treatment programs, some to the extent of reaching 80% of people living with HIV with antiretroviral therapy, the HIV prevention benefits of treatment that countries had hoped to achieve are not yet being realized. People are are not being diagnosed and treated soon enough, allowing transmissions to occur before they start treatment or if treatment is interrupted.

Botswana, for example, has nearly reached its 90–90–90* targets, as 86% of people living with HIV know their HIV status, 84% of people who know their status are on antiretroviral therapy and 81% of people on antiretroviral therapy are virally suppressed. However, new HIV infections have failed to see any declines since 2010.

To address the HIV prevention crisis and increase political commitment for HIV prevention, a Global HIV Prevention Coalition of United Nations Member States, donors, civil society organizations and implementers was established in 2017 that includes the 25 highest HIV burden countries.
The overarching goal of the Global HIV Prevention Coalition is to strengthen and sustain political commitment for primary HIV prevention by setting a common agenda—the HIV Prevention 2020 Road Map—among key policy-makers, funders and program implementers to accelerate progress towards reducing new HIV infections by 75% by 2020.

On 23 July 2018, the Global HIV Prevention Coalition came together at an event at the International AIDS Conference in Amsterdam, Netherlands, to discuss the urgency for scaling up HIV prevention, share progress made and address persisting challenges, including policy barriers and inadequate financing for HIV prevention.

This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”.More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

When Rommel, 51, tested HIV-positive, it was “accidental” – i.e. he was out clubbing with his BF and friends, and he just told his BF “why don’t we get tested?”

He recalled being surprised, though, why his BF’s rapid test was already done, and yet his still wasn’t; he even reprimanded the counselor, telling him to rush as the show in the club they were going to was already about to start.

“Atayun na nga, positive,” he said. His BF tested negative. And at that very moment, they became a serodifferent couple.

But also looking back, Rommel said a year prior to getting tested, he remembered getting really, really sick. It just so happened that his BF is a doctor, so they had contacts who helped make him get better. He also noted that he was treated with “lahat na (just about everything)” but that his HIV status was not even checked then.

And then – months after already getting better – he also had boils all over his upper body (neck included), so he said he sort of suspected something was up.

Perhaps – just perhaps – it was also because he had an open relationship and was engaged in unprotected sex with multiple sexual partners. “Sa totoo lang, dumating na yung point sa relationship namin na i-spice up ang sex life (To be honest, we reached a point in our relationship where we had to take steps to spice up/enliven our sex life),” he said. So they had threesomes, et cetera. “Siguro isa sa mga naka-threesome namin doon ako nakakuha ng HIV (Maybe I was infected by one of our sexual partners).”

After his baseline tests, Rommel’s CD4 count was found to be already “very low” – at 36. Not surprisingly, he needed to make lifestyle changes – e.g. if he used to party a lot in the past, and if his priority was to hang out with friends, “naging ang priority ko bigla, health (health suddenly became my priority).”

Rommel said that “wala naman blaming na naganap sa relationship namin (No blaming happened in our relationship)”. In fact, he thinks this made them closer.

His HIV status also made him appreciate family members (who were immediately told of his HIV status), particularly since they have been accepting of him. “Mas lalo ko naramdaman ano talaga ang ibig sabihin ng love (I really understood what love truly means)… I also appreciate them more now.”

Rommel believes in looking forward – and that includes when living with HIV.

“I hate the word ‘pagsisisi (regret)’,” he said.

To be more proactive, he – in fact – established Courage Pilipinas in 2018 as a support group for people living with HIV.

He advises for those who want to go into HIV advocacy to select who they work with/for; and not to allow oneself to be used by fake advocates.

For those who have yet to get themselves tested for HIV, Rommel said “huwag na kayong magpa-tumpik-tumpik pa (stop gallivanting).” He thinks that everyone should “normalize” HIV testing – as if one is just getting a haircut, manicure/pedicure, or even doing laundry.

And for people who have HIV, particularly those who were only recently diagnosed, “my message is… not to be ashamed. Don’t dwell on the past. Face what’s in front of you. Just fight on. And remembers, it’s just a virus.” – with Michael David C. Tan

Many barriers already prevent people from getting tested for HIV. But researchers now argue that interventions are urgently needed to also reach older adults and ethnic minorities to address HIV testing and beliefs.

As it is, many barriers already prevent people from getting tested for HIV, including lack of knowledge, competing priorities during medical visits, and stigma associated with the test on the part of both the patient and provider. But researchers now argue that interventions are urgently needed to also reach older adults and ethnic minorities to address HIV testing and beliefs.

The researchers argued that “not much is known, however, about what impact age and ethnicity have on HIV testing.”

Brown and colleagues explored data on self-reported HIV risk and willingness to be tested. They focused on age and ethnicity in the Coachella Valley in the US using the 2014 Get Tested Coachella Valley Community Survey. The team collected data from nearly 1,000 participants related to demographics, sexual history, HIV testing history, thoughts on who should get tested, and future preferences for HIV testing.

“Our recommendations to health care providers are that they talk directly with their patients during clinical visits about HIV prevention and HIV risk, and that they routinely offer HIV screening as part of primary care,” Brown said.

Brown added that interventions are needed to “debunk beliefs among physicians that older adults are not sexually active, and beliefs among older adults that only others are at risk of HIV.”

October highlighted the continuing disturbing worsening HIV situation in the Philippines, with an estimated 32 new HIV cases now happening in the country every day. For October, there were 1,072 new HIV cases reported to the HIV/AIDS & ART Registry of the Philippines (HARP).

It was in September when this number (i.e. 32 new HIV cases per day) was first reported. Prior to that, the country “only” had 31 new HIV cases reported daily, though even this figure was already considered high compared to figures from past years. In 2009, the country only had two new HIV cases per day. By 2015, the number increased to 22; and in the early part of 2018, the number was 31.

From January 1984 (when the first HIV case was reported in the country) to October 2018 (when the latest figures were belatedly – as usual – released by the HARP), the Philippines already had a total of 60,207 HIV cases. It is worth noting that 9,605 of that figure was reported from January to October 2018 alone.

MALES IN FOCUS

Those newly infected continue to be male – in October, of the 1,072 newly infected, 1,016 (95%) were male. The median age was 28 years old (age range: 2 – 67 years old). Half of the cases (50%, 537) were 25-34 years old and 29% (306) were 15-24 years old at the time of testing.

GEOGRAPHICAL DISTRIBUTION

Based on where those who tested HIV-positive originated, one third (32%, 343) were from the National Capital Region (NCR). Region 4A (17%, 187 cases), Region 3 (11%, 121), Region 7 (8%, 82), and Region 6 (7%, 76), round off the top five regions with the most number of newly diagnosed cases for the month, together accounting for 75% of the total.

Sexual contact remains the main mode of transmission (97%, 1,044). Among this, 86% were males who have sex with males (MSM). Other modes of transmission were needle sharing among injecting drug users (1%, 15) and vertical (formerly, mother-to-child) transmission (<1%, 2). There were 11 cases that had no data on mode of transmission.

Among the newly diagnosed females in October, eight were pregnant at the time of diagnosis. Five cases were from NCR and one case each from Regions 3, 4A and 7.

ACCESSING TREATMENT

In October, there were 831 patients who were initiated on antiretroviral therapy (ART). This is close to the figure registered in September, when 804 patients were initiated on ART. To date, a total of 32,324 people living with HIV (PLHIV) are on ART as of October; and this figure is still only a few thousand over the total number (60,207) of those who reported to have HIV in the country.

FOCUS ON THE YOUNG

Those getting infected continue to be also younger.

In October, 306 (29%) cases were among youth 15-24 years old; 94% were male. Almost all (98%, 300) were infected through sexual contact (31 male-female sex, 197 male-male sex, 72 sex with both males and females). There were six cases that had no data on mode of transmission.

There were also 41 newly diagnosed adolescents 10-19 years old in October. Almost all (95%) were infected through sexual contact (3 male-female sex, 31 male-male sex, and 5 had sex with both males and females); two had no data on mode of transmission. There were two newly diagnosed child less than 10 years old, and both were infected through mother-to-child transmission.

Even among overseas Filipino workers who tested HIV-positive, more were infected from male-to-male sexual contact.

Eighty-one people who worked overseas within the past five years of diagnosis, whether on land or at sea, were diagnosed HIV-positive in October. They comprise 8% of the total newly diagnosed cases for the month. Among them, 89% (72) were male. Almost all were infected through sexual contact (27 male-female sex, 32 male-male sex, and 21 sex with both males and females). The ages of male OFWs ranged from 23 to 55 years (median: 32 years). More than half (57%) of the cases belonged to the 25-34 year age group. Among the female OFWs diagnosed in October 2018, four cases were from the age groups 25-34 and 35-49; and one case was from 50 years old & older age group. The age range among diagnosed female OFWs were 28 to 61 years (median: 35 years).

ENGAGEMENT IN TRANSACTIONAL SEX

In October 2018, 14% (147) of the newly diagnosed engaged in transactional sex. Ninety-five percent (140) were male and aged from 20 to 64 years old (median: 30 years). More than half of the males (57%, 80) reported paying for sex only, 31% (43) reported accepting payment for sex only and 12% (17) engaged in both. Among the female cases who engaged in transactional sex, majority (71%, 5) were reported accepting payment in exchange for sex and 29% (2) reported paying for sex only.

Reporting on people who engage in transactional sex – or those who reported that they either pay for sex, regularly accept payment for sex, or do both – was only included in the HARP starting December 2012.

PREGNANT AND HIV-POZ

In October 2018, eight newly diagnosed cases were reported to be pregnant. Five were from NCR and one each from Regions 3, 4A and 7. The age of diagnosis ranged from 19 to 34 (median age: 23).

Reporting of pregnancy status at the time of testing was included in the HARP from the year 2011.

DEATHS AMONG PEOPLE WITH HIV

In October 2018, there were 30 reported deaths due to any cause among people with HIV. Ninety-seven percent (29) were males. One case (4%) was less than 15, four cases (13%) were 15-24, 12 cases (40%) were from 25-34, 10 cases (33%) were from 35-49, and three cases (10%) were 50 years and older age group. Almost all of the cases were reported to have acquired the infection through sexual contact (97%) (3 through male-female sex, 19 through male-male sex, and seven through sex with both males and females); while one case (3%) was infected through vertical transmission.

The 30 deaths are lower than the number reported in August, with reached 159 HIV-related deaths. But the figures are still believed to be be higher because of under- or non-reporting.

This is part of “More than a Number”, which Outrage Magazine launched on March 1, 2013 to give a human face to those infected and affected by the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in the Philippines, what it considers as “an attempt to tell the stories of those whose lives have been touched by HIV and AIDS”.
More information about (or – for that matter – to be included in) “More than a Number”, email editor@outragemag.com, or call (+63) 9287854244 and (+63) 9157972229.

Photo used for illustration purpose only; by Jason Schjerven from Unsplash.com

After being detained and deported, life was not easy. I felt I’ve went back to zero. I grieved a lot, and sometimes I thought I’ve reached the acceptance phase but the anger and sadness fluctuates every now and then. There was even a time that I went to RITM from my hometown by myself, and I was still struggling from my pneumonia and ARV allergic reaction. I needed to go back to my hub so I could refill my new ARV. I was on MRT train when I felt I was fainting so I’ve decided to sat on the floor to gain my strength and to avoid falling. It felt so terrible and lonely because as a nurse who used to take care different people, nobody cared to approach and ask me if I’m okay.

This is the reason why I realized that I need to focus on one of the most important aspect of my life, my health. Later on, I discovered twitter. I am grateful because this social media became a great support system to me because the of the fellow poz who have their account there. They have been very encouraging to my PLHIV journey, so I’m truly thankful to them. In fact, I have found some of my true best friends.They were there in supporting me in different ways, specially to my mental health.

When my health became stable, I started working from different fields. I hopped from the BPO industry, teaching International students and doing online jobs. I was upset because it was hard to start a clean slate. Maybe because deep in my heart, I hold this faith that there is still another world waiting for me, but this virus in my blood inhibits me, as well as the trauma I’ve had. Then I promised myself that my life will not end this way and just like the long-time drama anthology says “Ikaw ang bida ng buhay mo.”

I tried enriching my neurons by finishing my Master’s Degree and improving my English skill. I was spending my earnings in different classes and dealing my thesis. During that time, I was also rekindling my relationship to God. There was a time that I felt He left me, but I realized that during those lowest lows of my life, he was there all through out, but I couldn’t see him because I was blinded with frustration, anger and regrets.

After going through with my Master and passing my English test. I’ve received an information from another PLHIV that he knows a nurse who was accepted to work in UK to practice his profession, despite being a poz. That simple online conversation ignited a hope in my heart. Hence, I started applying for an overseas job again. I can still remember how much worry it caused me whenever I needed to disclose my HIV status to my prospective employers but I’m grateful that they don’t mind it.

To make the story short, I’m now in UK and I just passed my final exam to become a Registered Nurse here few weeks ago. It wasn’t an easy journey, but with perseverance, good health and divine intervention; I was able to fulfill this dream. I remember what Pope Francis said, “When you lose the capacity to dream, you lose the capacity to love, and the energy to love is lost.” This is my new mantra now.

To all my fellow PLHIV out there: life may seem to be a continuous struggle but continue learning and enriching yourself. Ask for help if you think you need one. Pain and sorrow is subjective. I may not know what you are going through but I sincerely wish everyone well.

Study links individual HPV types to HIV infection

Image used for illustration purpose only; photo by lucas clarysse from Unsplash.com

Individual types of the human papillomavirus (HPV) that are specifically linked to HIV infection have – for the first time – been identified.

In a study published in the journal PLOS ONE, a person with any HPV type, more than one HPV type, or high-risk HPV is more likely to acquire HIV. The study found the following HPV types are linked to HIV: HPV16, 18, 31, 33, 35, 52, 58.

“Although most studies have shown a general link between HPV and HIV co-infection, our findings illustrate the strong relationship between individual HPV types and HIV infection,” said Brandon Brown, an HIV researcher and associate professor in the UCR School of Medicine and lead author of the study. “Some HPV types are more linked to cancer and others to warts. This further illustrates the potential utility of HPV vaccine for men who have sex with men and trans women, not only for HPV prevention but also possibly for HIV prevention.”

Brown, a member of UCR’s Center for Healthy Communities, was joined in the study by Logan Marg of UCR; Segundo Leon at Socios En Salud, Lima, Peru; Cynthia Chen and Junice Ng Yi Siu of the National University of Singapore; Gino Calvo and Hugo Sanchez of Epicentro Salud, Lima, Peru; and Jerome T. Galea of the University of South Florida.

Previous research has shown that HPV, in general, was linked to HIV infection, but the new research team looked at infection with 37 HPV types and found that individual types are linked, “which is more specific than saying HPV is linked.”

The study investigated the relationship between HPV types and incident HIV infection among men who have sex with men (MSM) and transgender women in Lima, Peru. There were 600 participants recruited at a local community-based health center, bars, clubs, volleyball courts, and via social media. The researchers started with two groups, one with genital warts and one without, and followed participants over two years to see who contracted HIV. Of the 571 participants who completed at least two study visits, 73 acquired HIV in two years – a 6% HIV incidence rate.

Brown has been working in Peru for more than 10 years and has conducted preliminary work on HPV vaccine acceptability in MSM. In his previous work with female sex workers, he found that the HPV vaccine still provided protection to high-risk groups.

According to Brown, the results of the study are “absolutely applicable beyond Peru, and synergize with recent results of studies outside Peru.”

“The fact that our study took place in Peru is irrelevant,” Brown said. “It was simply convenient to do it there with our strong community connections and a high interest in this research.”

Regarding prevention and treatment, Brown recommends the HPV vaccine, widely provided to everyone, regardless of sex, gender, or sexual orientation, before sexual debut, as well as genital wart treatment.

“Even if the vaccine is not provided before sexual debut, there can be strong benefit if given at any time to prevent HPV-associated disease and also HIV,” he said. “We know that HPV is the most common STI, and we know that HPV vaccine works to prevent chronic HPV infection. What we need now is to implement the vaccine in a better way.”

Stressing U=U with a new research stating that there is a negligible risk of transmitting HIV during sex when a person living with HIV is on antiretroviral therapy and maintains a viral load under a specific threshold.

U=U; undetectable=untransmittable.

A newer study found – and backed – the already-established fact that there is a negligible risk of transmitting HIV during sex when a person living with HIV is on antiretroviral therapy and maintains a viral load under a specific threshold. In “Risk of sexual transmission of human immunodeficiency virus with antiretroviral therapy, suppressed viral load and condom use: a systematic review”, published in CMAJ (Canadian Medical Association Journal), the Public Health Agency of Canada conducted a systematic review that relied on 11 studies and one previously published review to determine the absolute risk of HIV transmission when preventive measures are in place.

“Our findings show that there is a negligible risk of sexually transmitting HIV when an HIV-positive sex partner adheres to antiretroviral therapy and maintains a suppressed viral load of less than 200 copies/mL on consecutive measurements every four to six months. The risk of sexual HIV transmission is low when an HIV-positive sex partner is taking antiretroviral therapy without a suppressed viral load of less than 200 copies/mL, condoms are used or both,” the researchers – which included Rachel Rodin from the Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada – stated.

The findings are of particular relevance, according to the researchers, in the drafting of laws.

In Canada, for instance, based on the findings of this study, as well as relevant case law and other factors, the Department of Justice Canada concluded that “the criminal law should not apply to people living with HIV who maintain a suppressed viral load of less than 200 copies/mL.”

Justice Canada also concluded that the criminal law should generally not apply to those who use condoms, among others.

Previous studies found that antiretroviral therapy and condoms can reduce HIV transmission. This study includes evidence from newer studies that have influenced clinical practice and could affect criminal law.